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Mizuiri S, Nishizawa Y, Doi T, Okubo A, Shigemoto K, Usui K, Arita M, Naito T, Doi S, Masaki T. Convection volume, β2-microglobulin and α1-microglobulin reduction ratios, and body composition in predilution online haemodiafiltration. Nephrology (Carlton) 2022; 27:601-609. [PMID: 35278013 DOI: 10.1111/nep.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
AIM The effect of convection volume (CV) in patients on predilution online haemodiafiltration (Pre-OL-HDF) was evaluated. METHODS We conducted a retrospective, cross-sectional study in 126 patients on Pre-OL-HDF. Dialysis conditions, laboratory data, and same day post-dialysis body composition measurements using bioimpedance spectroscopy were assessed. Patients were divided into two groups according to their CV: ≥ median value and < median value. Linear regression analyses for reduction ratios (RRs) of β2-microglobulin and α1-microglobulin, and body composition, were conducted. RESULTS Age, dialysis vintage, and CVs of the study patients were 64 ± 12 years, 81 (48-154) months, and 43.2 (38.5-55.9) L/session, respectively. The higher CV (≥ 43 L/session) group (n=66) had significantly higher RRs of β2-microglobulin and α1-microglobulin, lean tissue index, body cell mass index, total body water (TBW), extracellular water (ECW), and intracellular water (ICW) compared with the lower CV (< 43 L/session) group (n = 60; P < 0.01). Serum albumin and fat tissue index were not significantly different between the groups. CV/ECW, CV/TBW, and CV/ICW but not un-adjusted CV, were significant determinants for β2-microglobulin and α1-microglobulin RRs (P < 0.05). Lean tissue and body cell mass indexes, but not the fat tissue index, showed significant associations with CV, and RRs of β2-microglobulin and α1-microglobulin (P < 0.05). CONCLUSIONS Among patients on Pre-OL-HDF, higher values in the lean tissue index and body cell mass index were observed in those with higher CV versus lower CV, and CV adjusted to body water may be useful to prescribe individualized conditions for Pre-OL-HDF. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sonoo Mizuiri
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, Japan
| | - Yoshiko Nishizawa
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, Japan
| | - Toshiki Doi
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, Japan.,Department of Nephrology, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan
| | - Aiko Okubo
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, Japan.,Department of Nephrology, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan
| | - Kenichiro Shigemoto
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, Japan
| | - Koji Usui
- Ichiyokai Ichiyokai Clinic, 10-3 Asahien, Saeki-ku, Hiroshima, Japan
| | - Michiko Arita
- Iciyokai East Clinic, 1-3-53 Danbaraminami Minami-ku, Hiroshima, Japan
| | - Takayuki Naito
- Ichiyokai Yokogawa Clinic, 2-7-9 Yokogawacho Nishi-ku, Hiroshima, Japan
| | - Shigehiro Doi
- Department of Nephrology, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan
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Apel C, Hornig C, Maddux FW, Ketchersid T, Yeung J, Guinsburg A. Informed decision-making in delivery of dialysis: combining clinical outcomes with sustainability. Clin Kidney J 2021; 14:i98-i113. [PMID: 34987789 PMCID: PMC8711764 DOI: 10.1093/ckj/sfab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 12/31/2022] Open
Abstract
As the prevalence of chronic kidney disease is expected to rise worldwide over the next decades, provision of renal replacement therapy (RRT), will further challenge budgets of all healthcare systems. Most patients today requiring RRT are treated with haemodialysis (HD) therapy and are elderly. This article demonstrates the interdependence of clinical and sustainability criteria that need to be considered to prepare for the future challenges of delivering dialysis to all patients in need. Newer, more sustainable models of high-value care need to be devised, whereby delivery of dialysis is based on value-based healthcare (VBHC) principles, i.e. improving patient outcomes while restricting costs. Essentially, this entails maximizing patient outcomes per amount of money spent or available. To bring such a meaningful change, revised strategies having the involvement of multiple stakeholders (i.e. patients, providers, payers and policymakers) need to be adopted. Although each stakeholder has a vested interest in the value agenda often with conflicting expectations and motivations (or motives) between each other, progress is only achieved if the multiple blocs of the delivery system are advanced as mutually reinforcing entities. Clinical considerations of delivery of dialysis need to be based on the entire patient disease pathway and evidence-based medicine, while the non-clinical sustainability criteria entail, in addition to economics, the societal and ecological implications of HD therapy. We discuss how selection of appropriate modes and features of delivery of HD (e.g. treatment modalities and schedules, selection of consumables, product life cycle assessment) could positively impact decision-making towards value-based renal care. Although the delivery of HD therapy is multifactorial and complex, applying cost-effectiveness analyses for the different HD modalities (conventional in-centre and home HD) can support in guiding payability (balance between clinical value and costs) for health systems. For a resource intensive therapy like HD, concerted and fully integrated care strategies need to be urgently implemented to cope with the global demand and burden of HD therapy.
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Affiliation(s)
- Christian Apel
- Health Economics and Market Access EMEA, Fresenius Medical Care, Bad Homburg, Germany
| | - Carsten Hornig
- Health Economics and Market Access EMEA, Fresenius Medical Care, Bad Homburg, Germany
| | - Frank W Maddux
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | | | - Julianna Yeung
- Health Economics & Market Access Asia-Pacific, Fresenius Medical Care, Hong Kong
| | - Adrian Guinsburg
- Global Medical Office, Fresenius Medical Care, Buenos Aires, Argentina
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Côté JM, Pinard L, Cailhier JF, Lévesque R, Murray PT, Beaubien-Souligny W. Intermittent Convective Therapies in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis. Blood Purif 2021; 51:75-86. [PMID: 33902049 DOI: 10.1159/000515641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In critically ill patients requiring intermittent renal replacement therapy (RRT), the benefits of convective versus diffusive clearance remain uncertain. We conducted a systematic review and meta-analysis to determine the safety, clinical efficacy, and clearance efficiency of hemofiltration (HF) and hemodiafiltration (HDF) compared to hemodialysis (HD) in patients with acute kidney injury (AKI) receiving intermittent RRT. METHOD We searched Medline, Embase, Cochrane Library, and PROSPERO. We included clinical trials and observational studies that reported the use of intermittent HF or HDF in adult patients with AKI. The following outcomes were included: mortality, renal recovery, clearance efficacy, intradialytic hemodynamic stability, circuit loss, and inflammation modulation. RESULTS A total of 3,169 studies were retrieved and screened. Four randomized controlled trials and 4 observational studies were included (n: 615 patients). Compared with conventional HD, intermittent convective therapies had no effect on in-hospital mortality (relative risk, 1.23; 95% confidence interval (CI), 0.76-1.99), renal recovery at 30 days (RR, 0.98; 95% CI, 0.82-1.16), time-to-renal recovery (mean difference [MD], 0.77; 95% CI, -6.56 to 8.10), and number of dialysis sessions until renal recovery (MD, -1.34; 95% CI, -3.39 to 0.72). The overall quality of included studies was low, and dialysis parameters were suboptimal for all included studies. CONCLUSION This meta-analysis suggests that there is no significant difference in short-term mortality and renal recovery in patients with severe AKI when treated with intermittent HF or HDF compared to conventional HD. This systematic review emphasizes the need for further trials evaluating optimal convective parameters in AKI patients treated with intermittent dialysis.
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Affiliation(s)
- Jean Maxime Côté
- Division of Nephrology, Department of Medicine, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.,Research Centre (CRCHUM), Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.,Clinical Research Centre, University College Dublin, Dublin, Ireland
| | - Louis Pinard
- Division of Nephrology, Department of Medicine, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
| | - Jean-Francois Cailhier
- Division of Nephrology, Department of Medicine, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.,Research Centre (CRCHUM), Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
| | - Renée Lévesque
- Division of Nephrology, Department of Medicine, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.,Research Centre (CRCHUM), Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
| | - Patrick T Murray
- Clinical Research Centre, University College Dublin, Dublin, Ireland.,Division of Nephrology, Department of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - William Beaubien-Souligny
- Division of Nephrology, Department of Medicine, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.,Research Centre (CRCHUM), Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
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4
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AlSahow A, Muenz D, Al-Ghonaim MA, Al Salmi I, Hassan M, Al Aradi AH, Hamad A, Al-Ghamdi SMG, Shaheen FAM, Alyousef A, Bieber B, Robinson BM, Pisoni RL. Kt/V: achievement, predictors and relationship to mortality in hemodialysis patients in the Gulf Cooperation Council countries: results from DOPPS (2012-18). Clin Kidney J 2021; 14:820-830. [PMID: 33777365 PMCID: PMC7986324 DOI: 10.1093/ckj/sfz195] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dialysis adequacy, as measured by single pool Kt/V, is an important parameter for assessing hemodialysis (HD) patients' health. Guidelines have recommended Kt/V of 1.2 as the minimum dose for thrice-weekly HD. We describe Kt/V achievement, its predictors and its relationship with mortality in the Gulf Cooperation Council (GCC) (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates). METHODS We analyzed data (2012-18) from the prospective cohort Dialysis Outcomes and Practice Patterns Study for 1544 GCC patients ≥18 years old and on dialysis >180 days. RESULTS Thirty-four percent of GCC HD patients had low Kt/V (<1.2) versus 5%-17% in Canada, Europe, Japan and the USA. Across the GCC countries, low Kt/V prevalence ranged from 10% to 54%. In multivariable logistic regression, low Kt/V was more common (P < 0.05) with larger body weight and height, being male, shorter treatment time (TT), lower blood flow rate (BFR), greater comorbidity burden and using HD versus hemodiafiltration. In adjusted Cox models, low Kt/V was strongly related to higher mortality in women [hazard ratio (HR) = 1.91, 95% confidence interval (CI) 1.09-3.34] but not in men (HR = 1.16, 95% CI 0.70-1.92). Low BFR (<350 mL/min) and TT (<4 h) were common; 41% of low Kt/V cases were attributable to low BFR or TT (52% for women and 36% for men). CONCLUSION Relatively large proportions of GCC HD patients have low Kt/V. Increasing BFR to ≥350 mL/min and TT to ≥4 h thrice weekly will reduce low Kt/V prevalence and may improve survival in GCC HD patients-particularly among women.
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Affiliation(s)
- Ali AlSahow
- Nephrology Division, Jahra Hospital, Jahra, Kuwait
| | - Daniel Muenz
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Mohammed A Al-Ghonaim
- Medicine Department, Saudi Center for Organ Transplantation, King Saud University, Riyadh, KSA
| | - Issa Al Salmi
- Renal Medicine Department, Royal Hospital, Muscat, Oman
| | - Mohamed Hassan
- Nephrology Division, Shaikh Khalifa Medical Center, Abu Dhabi, UAE
| | - Ali H Al Aradi
- Nephrology Division, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Saeed M G Al-Ghamdi
- Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA
| | | | - Anas Alyousef
- Nephrology Division, Farwaniya Hospital, Sabah AlNasser, Kuwait
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
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5
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Brannigan L. Renal replacement. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.6.s3.2530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There are few, if any, technological advancements in the field of medicine that have been able to transform a life-threatening condition, in this case, end-stage renal failure, from a certain and horrible death, just some 100 years ago, to a condition manageable within the confines of one’s home. This refresher course, by no means a comprehensive text on peritoneal or haemodialysis, aims to provide the reader (a pre-part one FCA candidate) with the following brief overview:
* A short history of dialysis
* The basic physiology of fluid and solute exchange employed in renal replacement therapy (RRT)
* The physical principals of RRT
* Modality
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6
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Scherer PF, Iizuka IJ, Ammirati AL, Doher MP, Matsui TN, Dos Santos BFC, Monte JCM, Batista MC, Pereira VG, Dos Santos OFP, Durão MDS. Intermittent hemodiafiltration as a down-step transition therapy in patients with acute kidney injury admitted to intensive care unit who initially underwent continuous venovenous hemodiafiltration. Int J Artif Organs 2020; 44:223-228. [PMID: 32907438 DOI: 10.1177/0391398820952801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Continuous renal replacement therapies (CRRT) are initially employed in patients with acute kidney injury (AKI) in ICU setting. After the period of serious illness, hemodialysis is usually used as a mode of transition from CRRT. Intermittent hemodiafiltration (HDF) is not commonly applied in this scenario. OBJECTIVES To evaluate the feasibility of using HDF as transition therapy after CVVHDF in critically patients with AKI. METHODS An observational and prospective pilot study was conducted in ICU patients with dialysis-requiring AKI. Patients were initially treated with CVVHDF and, after medical improvement, those who still needed renal replacement therapy were switched to HDF treatment. RESULTS Ten Patients underwent 53 HDF sessions (mean of 5.3 sessions/patient). The main cause of renal dysfunction was sepsis (N = 7; 70%). The APACHE II mean score was 27.6 ± 6.9. During HDF treatment, the urea reduction ratio was 64.5 ± 7.5%, for β-2 microglobulin serum levels the percentage of decrease was 42.0 ± 7.8%, and for Cystatin C was 36.2 ± 6.9%. Five episodes of arterial hypotension occurred (9.4% of sessions). There were 20 episodes of electrolytic disturbance (37.7% of sessions), mainly hypophosphatemia. No pyrogenic or suggestive episode of bacteremia was observed. CONCLUSION Hemodiafiltration was safe and efficient to treat critically ill patients with acute kidney injury during the transition phase from continuous to intermittent dialysis modality. Special attention should be paid regarding the occurrence of electrolytic disturbance, mainly hypophosphatemia.
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Affiliation(s)
- Patricia Faria Scherer
- Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Adriano Luiz Ammirati
- Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marisa Petrucelli Doher
- Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Thais Nemoto Matsui
- Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bento Fortunato Cardoso Dos Santos
- Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Dialysis Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Marcelo Costa Batista
- Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Nephrology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | | | - Oscar Fernando Pavão Dos Santos
- Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Nephrology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Marcelino de Souza Durão
- Nephrology Division, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Nephrology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.,Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
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7
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AlSahow A, AlHelal B, Alyousef A, AlQallaf A, Marzouq A, Nawar H, Fanous G, Abdelaty M, Bahbahani Y, AlRajab H, AlTerkait A, Ali H. Renal Data from the Arab World Dialysis in Kuwait: 2013-2019. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:826-830. [PMID: 32801244 DOI: 10.4103/1319-2442.292317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The total number of end-stage kidney disease patients treated with dialysis in 2019 in Kuwait was 2230, with a 6% increase from the year before. Dialysis prevalence was 465 per million population (PMP) and dialysis incidence was100 PMP. Kuwaiti nationals represented 70% of the dialysis population and males represented 52%. Of the same population, 59% had diabetes. Hepatitis C virus affected <4% and hepatitis B virus affected <2% of the dialysis population. The annual mortality rate was stable at around 12%. Hemodialysis (HD) share was 89%, with 48% of HD patients getting HD via catheter, 54% on hemodiafiltration (HDF), and 50% dialyzing against a calcium bath of 1.75. Patients getting <3 times/week of HD constituted 10% and patients spending <3.5 h/session constituted 11%. We had only 20 dialysis patients under the age of 12 years (12 on HD). The major challenges faced included poor peritoneal dialysis penetration, the unacceptable high rates of catheters as primary HD vascular access, partly due to lack of chronic kidney disease (CKD) clinics and lack of vascular access coordinators, and the unexplained high rates of use of calcium bath of 1.75. There is also a need for a national campaign for early detection and prevention of CKD to reduce rates of end-stage renal disease.
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Affiliation(s)
- Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
| | | | - Anas Alyousef
- Division of Nephrology, Amiri Hospital, Kuwait City, Kuwait
| | - Ahmad AlQallaf
- Division of Nephrology, Mubarak Hospital, Jabriya, Kuwait
| | - Ayman Marzouq
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
| | - Hani Nawar
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
| | - George Fanous
- Division of Nephrology, Adan Hospital, Hadiya, Kuwait
| | | | | | - Heba AlRajab
- Division of Nephrology, Farwaniya Hospital, Sabah Al Nasser, Kuwait
| | - Aisha AlTerkait
- Division of Pediatric Nephrology, Mubarak Hospital, Jabriya, Kuwait
| | - Hamad Ali
- Department of Medical Laboratories Faculty of Allied Health Sciences Kuwait University, Jabriya; Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Kuwait
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8
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Bolasco P. The production of on-line dialysis water for extracorporeal dialysis: proposals for an increased safety upgrade: a viewpoint. J Nephrol 2020; 33:405-415. [PMID: 31713828 PMCID: PMC7220975 DOI: 10.1007/s40620-019-00667-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION At the start of the 2000s, the progressive diffusion of high-flux extracorporeal dialysis and membranes saw an increased use of high infusion volumes injected into the patient's blood circuit following the advent of on-line water production plants. METHODOLOGY Our 15-year experience with on-line extracorporeal methodologies using very high infusion volumes has led to the detection of errors and weaknesses, thus allowing us to correct and provide for the implementation of appropriate technology in dialysis water production plants with the aim of ensuring a higher chemical-physical, bacteriological and endotoxin quality. The initial procedures had already been outlined in the 2005 Italian Guidelines, although still today Health Technicians and Nephrologists operating in the field are unable to take on board specific integrations for on-line methods due to a lack of upgrading of documentation in both European and non-European Guidelines. RESULTS After more than 17 years' experience, and in view of the technological implementations developed since 2005, we wish to put forward a series of suggestions in an attempt to improve the safety of on-line water, with uses ranging from drinking water, pre-treatment, osmosis, distribution circuit, hemodialysis monitors up to the most recent update of microbiological cultures. DISCUSSION Additional, more stringent measures are required to prevent the occurrence of acute accidents during dialysis sessions and to reduce chronic inflammation-oxidation deriving from the use of not totally ultra-pure/sterile dialysis fluids. CONCLUSION Our point of view based on our long-standing experience, the proposals made relate to procedures to be applied in technological maintenance, which the consultant nephrologist and other relevant personnel such as microbiologists, biologists, and technical operators should adhere to rigorously to ensure that the production of dialysis water on-line is viewed on a par with a pharmacological administration.
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9
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Choo SZ, Polkinghorne KR, Kerr PG. Biochemical comparison of 8 h haemodialysis and 4 h haemodiafiltration, and two dialysis membranes, in a randomized cross-over trial. Nephrology (Carlton) 2019; 24:542-549. [PMID: 29722110 DOI: 10.1111/nep.13397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 11/28/2022]
Abstract
AIM Extended-hours haemodialysis has long been regarded as the optimal form of dialysis for solute clearance. With emerging benefits of haemodiafiltration, we wanted to compare these two head-to-head. METHODS In this randomized cross-over trial, we recruited existing nocturnal haemodialysis patients, who had not been hospitalized in the prior 3 months. After a baseline 8 h haemodialysis session, subjects were randomized to either 2 weeks of 8 h haemodialysis or 4 h haemodiafiltration with cross-over to the alternative treatment after a 2-week washout period. Subjects were additionally randomized to the Fresenius FX80 or Nipro Elisio in a parallel design. Blood and dialysate samples were collected at baseline and at the end of both study periods. RESULTS Twelve patients completed the study. Mean (SD) age and body mass index were 55.1 ± 11.5 years and 36.4 ± 10.8, respectively. Urea and creatinine reduction ratios were higher with extended-hours haemodialysis compared to haemodiafiltration (difference 14.0%, 95% CI = 10.6, 17.3; P < 0.001 and 9.1%, 95% CI = 11.0, 7.2; P < 0.001). Fibroblast growth factor 23 (FGF23) clearance was superior with haemodiafiltration (difference 20.1%, 95% CI = 8.7, 31.6; P = 0.001). No difference was seen in reduction ratios for phosphate, retinol binding protein, alpha-1-microglobulin, beta-2-microglobulin and fetuin with both modalities. Compared to Nipro Elisio, Fresenius FX80 dialyser achieved higher beta-2-microglobulin clearance (Period 1: difference 7.8%, 95% CI = 1.3, 14.4; P = 0.02, Period 2:7.5%, 95% CI = 1.0, 14.1; P = 0.02). CONCLUSIONS Small solute clearance was superior with extended-hours haemodialysis while haemodiafiltration enhanced FGF23 clearance. Beta-2-microglobulin clearance was improved with Fresenius FX80 dialyser, but this difference is unlikely to be clinically significant.
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Affiliation(s)
- Shi Z Choo
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia
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Macías N, Vega A, Abad S, Santos A, Cedeño S, Linares T, García-Prieto AM, Aragoncillo I, Yuste C, López-Gómez JM. Is High-Volume Online Hemodiafiltration Associated With Malnutrition? Ther Apher Dial 2018; 21:361-369. [PMID: 28834362 DOI: 10.1111/1744-9987.12602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/01/2016] [Accepted: 01/12/2017] [Indexed: 12/16/2022]
Abstract
Chronic malnutrition is a common problem in patients with end-stage renal disease on hemodialysis. Some studies have reported albumin loss into dialysis fluid during postdilution online hemodiafiltration (OL-HDF). The aim of the study was to assess the nutritional status of patients on high-volume OL-HDF and to demonstrate that higher convective clearances are not associated with malnutrition due to possible loss of nutrients with ultrafiltration. Demographic and clinical data, corporal composition with bioimpedance spectroscopy, dialysis features, albumin loss into dialysis fluid and laboratory parameters were collected in twenty-eight patients with ESRD undergoing postdilution OL-HDF with stable convective volumes over 28 L/session. Convective volume (CV) in the last six months was 32.51 ± 3.52 L per session. Cross-sectional analysis of dialysis features showed 32.7 ± 3.34 L of CV and high reduction rates of beta-2-microglobulin (84.2 ± 3.8%) and cystatin-C (81.6 ± 3.47%). Beta-2-microglobulin reduction showed a positive correlation with prealbumin levels (P = 0.048). CV was only correlated with cystatin-C reduction (P = 0.025). Estimated albumin loss into dialysis fluid (1.82 ± 1.05 g/session) was not related to laboratory or bioimpedance nutritional parameters, or to CV. Among patients with higher CV, serum albumin levels maintained more stability during the observational period. High volume OL-HDF results in better convective clearances and is not associated with malnutrition. Albumin and nutrients loss into dialysis fluid should not be a limiting factor of the substitution volume.
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Affiliation(s)
- Nicolás Macías
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Almudena Vega
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Soraya Abad
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Alba Santos
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Santiago Cedeño
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Tania Linares
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
| | | | | | - Claudia Yuste
- Nephrology Department, Hospital Gregorio Marañón, Madrid, Spain
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Marano M, D’Amato A, Cantone A. Carbon dioxide: Global warning for nephrologists. World J Nephrol 2016; 5:429-36. [PMID: 27648406 PMCID: PMC5011249 DOI: 10.5527/wjn.v5.i5.429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/02/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023] Open
Abstract
The large prevalence of respiratory acid-base disorders overlapping metabolic acidosis in hemodialysis population should prompt nephrologists to deal with the partial pressure of carbon dioxide (pCO2) complying with the reduced bicarbonate concentration. What the most suitable formula to compute pCO2 is reviewed. Then, the neglected issue of CO2 content in the dialysis fluid is under the spotlight. In fact, a considerable amount of CO2 comes to patients' bloodstream every hemodialysis treatment and "acidosis by dialysate" may occur if lungs do not properly clear away this burden of CO2. Moreover, vascular access recirculation may be easy diagnosed by detecting CO2 in the arterial line of extracorporeal circuit if CO2-enriched blood from the filter reenters arterial needle.
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Kim YW, Park S. Confronting Practical Problems for Initiation of On-line Hemodiafiltration Therapy. Electrolyte Blood Press 2016; 14:1-4. [PMID: 27453712 PMCID: PMC4949201 DOI: 10.5049/ebp.2016.14.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/22/2016] [Indexed: 11/10/2022] Open
Abstract
Conventional hemodialysis, which is based on the diffusive transport of solutes, is the most widely used renal replacement therapy. It effectively removes small solutes such as urea and corrects fluid, electrolyte and acid-base imbalance. However, solute diffusion coefficients decreased rapidly as molecular size increased. Because of this, middle and large molecules are not removed effectively and clinical problem such as dialysis amyloidosis might occur. Online hemodiafiltration which is combined by diffusive and convective therapies can overcome such problems by removing effectively middle and large solutes. Online hemodiafiltration is safe, very effective, economically affordable, improving session tolerance and may improve the mortality superior to high flux hemodialysis. However, there might be some potential limitations for setting up online hemodiafiltaration. In this article, we review the uremic toxins associated with dialysis, definition of hemodiafiltration, indication and prescription of hemodiafiltration and the limitations of setting up hemodiafiltration.
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Affiliation(s)
- Yang Wook Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sihyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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